Provider Demographics
NPI:1669928677
Name:PSYCHOLOGICAL ASSESSMENT AND SCREENING SERVICES PC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT AND SCREENING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-818-8383
Mailing Address - Street 1:400 S OYSTER BAY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3500
Mailing Address - Country:US
Mailing Address - Phone:516-818-8383
Mailing Address - Fax:516-605-1181
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-818-8383
Practice Address - Fax:516-605-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty